Provider Demographics
NPI:1699065037
Name:EMERALD VENTURE
Entity type:Organization
Organization Name:EMERALD VENTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-382-9893
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:BARKER
Mailing Address - State:TX
Mailing Address - Zip Code:77413-0293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11602 VETERANS MEMORIAL DR
Practice Address - Street 2:SUITE E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-2606
Practice Address - Country:US
Practice Address - Phone:713-382-9893
Practice Address - Fax:713-382-9893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty